Inpatients falling under the effects of hypnotic agent

Hospital patients taking the commonly prescribed hypnotic agent zolpidem are at an increased risk for falls, which in turn significantly increase morbidity and healthcare costs, say US researchers.

"We calculate that for every 55 inpatients administered zolpidem, we might expect one more fall than would otherwise have occurred," lead author Timothy Morgenthaler, from the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minnesota, said in a press statement.

"As a result of our study, we are now phasing out zolpidem and moving toward sleep enhancement techniques that are not based on drugs and which we believe are safer and probably as effective."

Fall reduction in hospitals is one of the target aims of the Department of Health and Human Services Partnership for Patients, the researchers explain, so an association between falls and zolpidem could make zolpidem use a potentially modifiable risk factor.

The study, published in the Journal of Hospital Medicine, shows that the fall rate among 4962 patients who were prescribed and took zolpidem during their hospital stay was significantly increased, at more than four times as high as that for 11,358 patients who were prescribed the drug but did not take it (3.04 vs 0.71%).

The researchers also found that the risk posed by the drug was greater than the risks posed by factors such as age, cognitive impairment, delirium, or insomnia, regardless of the dosage used.

"Navigating obstacles in a hospital setting, where the patient is in a novel environment and on other medications that could impact balance, is potentially made significantly worse by zolpidem, thus resulting in increased falls," they report.

"Presently, because there is limited evidence to recommend other hypnotic agents as safer alternatives in inpatient setting, non-pharmacological measures to improve the sleep of hospitalized patients should be investigated as preferred methods to provide safe relief from complaints of disturbed sleep," the team concludes.

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